Summaries for Patients|19 June 2012

Hospitalization and Delirium in Persons With Alzheimer Disease

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The full report is titled “Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease.” It is in the 19 June 2012 issue of Annals of Internal Medicine (volume 156, pages 848-856). The authors are T.G. Fong, R.N. Jones, E.R. Marcantonio, D. Tommet, A.L. Gross, D. Habtemariam, E. Schmitt, L. Yap, and S.K. Inouye.

What is the problem and what is known about it so far?

Evidence shows that patients with Alzheimer disease (AD) are much more likely to be hospitalized than other older people. If hospitalized, older people often develop delirium, and those with AD are at an even greater risk for this complication. Many clinical observations and small studies have suggested that hospitalization of patients with AD, especially if delirium occurs, causes further cognitive decline, leads to the need for nursing home placement, and increases the risk for death.

Why did the researchers do this particular study?

To directly compare a group of hospitalized patients with AD with similar patients with AD who were not hospitalized to better determine the risk for bad outcomes due to hospitalization and to delirium occurring during hospitalization.

Who was studied?

A large group of community-dwelling older people living in Massachusetts, who receive their clinical care from a specialized research center.

How was the study done?

Data collected directly from patients as part of the study were combined with data from medical records, the Social Security Death Index, and other data sources.

What did the researchers find?

Patients with AD who are hospitalized for any reason are more likely to die than patients with AD who are not hospitalized. If they survive hospitalization, they are more likely to require placement in an institutional facility, such as a nursing home. Of great importance, the occurrence of delirium in patients with AD substantially increased these risks compared with patients with AD who did not develop delirium. The authors estimate that 6% of deaths, 15% of institutionalizations, and 21% of cases of cognitive decline in hospitalized patients with AD can be associated with delirium.

What were the limitations of the study?

Although a study like this cannot prove that delirium directly caused death, institutional-ization, or other bad outcomes, it suggests that this is the case.

What are the implications of the study?

When faced with the decision to hospitalize a loved one with AD, caregivers may want to ask health care providers to carefully consider whether alternatives to hospitalization can be identified. If hospitalization is necessary, then efforts should be made to prevent delirium. Caregivers of patients with AD should realize that hospitalization often marks a substantial downturn in the course of AD, especially if delirium ensues, and should plan for the increased support that their loved ones, and they, may need if it occurs.

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